FEATURE

Risk factors Vs. Asset factors

Prof. B. M. Hegde,

“This world was never about TRUTH or LIES. There are only hard facts. Despite that, some who exist in this world mistakenly believes that only FACTS FAVORABLE TO THEM are truths. They know no other way to live. Do you know all the Facts?”

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Risk factors for any disease, especially for life style diseases, are another big business. Almost every known thing is cited as a risk factor. If one carefully reads a recent medicine textbook heart attacks have more than one hundred risk factors! People goad you to get yourself checked up regularly by regular screening to lessen your risk factor dangers. There are many studies of risk factors which are small cohort studies done for a short time slot, so called cross sectional studies, mostly funded by the vested interests, which proclaim that every single risk factor needs to be actively pursued and treated (controlled) vigorously. The main line media, both print and electronic, is made to pick up these studies to focus public attention on them thus creating a conducive environment to sell their drugs or other interventional methods to make money. To the best of my information none of these studies has ever followed up the same cohort for longer than five years to see the long term interventional outcomes of those risk factor controlling strategies!

When the industry finds that their product is dangerous to health they devise “scientific” studies to show how their product is good for health. One example will suffice. In the early 1970s new insights in the medical world showed how dangerous alcohol is to the heart. The advent of alcoholic cardiomyopathy as a dangerous cause of sudden death, even more dangerous than heart attacks, was discovered in Russia by Maurice Lev and his associate Saroja Bharati. THE ALCOHOL INDUSTRY IN Europe devised a new study by inviting alcohol experts from all over the world for a long session at the Dorchester Hotel in London with a brief to get a “scientific” paper to show that alcohol in small doses is very good for the heart and also to prevent a heart attack. They all obliged. Their paper saw the light of the day in the journal Heart in 1981 with an editorial by the then editor urging doctors to proactively ask people to drink in small quantities for heart health. Dr. Eric Oliver from Chicago University in his paper The Politics of Pathologyhow obesity became an epidemic disease shows how the epidemic of obesity is created by the industry to sell their obesity reducing drugs and surgical technics.

The longest prospective study of risk factors was the (in) famous MRFIT study-multiple risk factor interventional trial, which started by screening 500,000 Americans to select 100,000 participants who now have completed 25 years of observation. The final conclusion of the study, having spent millions of American Tax Payers’ money, was: there have been no risk factors in MRFIT study. The so called risk factors could be effectively controlled by interventions, drugs and surgery but, the final risk, when present, will remain intact and the intervention does not make any difference. So there are nothing called risk factors! My take on this study is that the study shows the hollowness of two things. One is that risk factor theory is created to sell their wares by the industry and secondly, the patients whose risk factors were controlled had to recover twice as William Osler had written decades ago:

"The person who takes medicine must recover twice,

Once from the disease and once from the medicine"

-William Osler,

Many of them in the MRFIT study had to meet their maker in heaven prematurely, though. That much for the risk factor hypothesis.

Some years ago I had coineda neologism-asset factor. If one looks at the other side of the risk factor coin we see that a large number of humans that have similar risk factors do not suffer from any disease. A telling example would be simple malaria. In Mangalore on a given day there might be about a dozen patients with malaria in many of the hospitals put together. There are more than 15,00,000 humans live in Mangalore. The large majority of 14,99,990 people with the same mosquito bite do not suffer from Malaria. Logically there must be something in that majority that prevents them from getting malaria despite the mosquito bite. It might be their immune resistance, their diet, their life style etc. It was an American physician, Theobald Smith, who in 1915 propounded the Grimm’s Law which states that “while any disease is directly proportionate to the virulence of its cause, it is also inversely proportionate to the resistance of the host.” The host resistance is what is keeping us alive in the midst of the sea of risk factors. On a given day there might be a few million suffering patients but there are more than six billion that are healthy and kicking. If medicine were to be a philanthropic enterprise without the lure for big money returns mankind would have been happy because doctors were goaded to “cure rarely, comfort mostly but to console always.” But alas! Today almost all patients have to recover twice if they are lucky-once from the disease and once from the medicines and interventions.

Let me conclude by quoting Eric Oliver again: “it is useful to understand how “new ideas” become widelyaccepted. Scholars of diffusion theory have long recognized that fads, innovations,and trends often accelerate across populations in exponential fashion, muchin the same way that contagious diseases do (Rogers 1962). One day a singleperson pierces her navel or rolls up his pant cuffs and then, suddenly, everyone isdoing it (Gladwell 2000).The key for the spread of a new idea, like the spreadof a disease, is having the right set of circumstances and a particularly goodmethod of transmission. The HIV virus, for example, allegedly spread out ofAfrica in the early 1980s because of the international promiscuity of a singleCanadian airline steward, Gaetan Dugas, the infamous “patient zero” (Shilts1987).The same holds true for ideas: a new concept lies fallow for a time untila triggering event, particular circumstance, or the right person suddenly causesit to be embraced by a large number of people.”

Long live mankind on this planet despite this kind of non-science.

“Lies can't grow. Once plucked they can only wither. But every truth, once planted, grows into a tall, noble tree. ”

Stefan Emunds